Running head: PICC LINES

Evidence Based Practice for Peripherally Inserted Central Catheter (PICC) Lines Lisa N. Dust Ferris State University

PICC LINES Evidence based practice for peripherally inserted central catheter (PICC) lines Evidence base practice has become the standard for nursing practices within health care systems. Evidence based practice (EBP) in nursing is a problem-solving approach to making clinical decisions, using the best evidence available. EVP blends both the science and the art of

nursing so that the best patient outcomes are achieved (Taylor, 2011, p. 78). Through using the techniques that have been proven effective through the studies, this can state that those methods are the best practice when partaking in the procedure. There are concerns for health care settings and one of the most prevalent issues is the risk for infection, especially when placing a line directly into the bloodstream, such as a peripherally inserted central catheter (PICC). Correlating When the decision is made to implement an invasive procedure such as a PICC line insertion, there are variables that must be taken into account and the proper techniques must be used to cause the least amount of harm to the patient. According to Petree, Wright, Sanders, and Killion (2012) these proper techniques include: securement, sterility of site, minimal moisture to site, comfort for the patient, and education. In correlating those techniques to the Institute for Healthcare Improvement (2008), there is a bundle that has five components which include hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity with prompt removal of unnecessary lines. While these articles have used research and evidence based practices to demonstrate that these techniques are proving to be the best choice when implementing a PICC line, there are still areas that need to have further research completed. Similarities There are multiple areas of similarities between the articles for Petree, Wright, Sanders, and Killion (2012) and the Institute for Healthcare Improvement (2008). However some of the

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techniques are more detailed and precise. Both state that hand hygiene is of upmost importance. This is the basic first step to keeping the amount of microorganisms to a minimum. Then protective equipment is incorporated along with sterile equipment that includes caps, masks, gowns, gloves, and drapes, which is also called maximal barrier precautions. This protects the patient along with the health care providers who are administering this procedure. Preparation of the catheter site includes cleaning the insertion site properly and correct placement of the line. Education and daily review of the site must be implemented to make sure that guidelines are followed to decrease the risk for infection by maintaining the PICC line integrity. Differences While these evidence based practiced have many areas that correlate between both articles, there are variances that arise. As stated by Petree, Wright, Sanders, and Killion (2012) securement of a PICC line keeps the site stable and there are multiple avenues to ensure securement such as self-adhesive devices like tape and sutures. As well as minimizing the amount of moisture near the site of the PICC line, because moisture promotes the growth of bacteria and skin breakdown. Correlating this to the comfort for the patient, because through keeping the site comfortable it prevents excessive irritation to the site, which may entice the patient to touch and potentially increase their risk for infection. In comparison, the Institute for Healthcare Improvement (2008) is very detailed in the guide. In cleaning the skin for PICC line insertion it is clearly stated that chlorhexidine skin antisepsis is to be used for this procedure due to the fact that multiple studies proved it to be a better skin antisepsis. Another area was the daily review of the PICC line site. This pertains to the fact that the longer the line is in place, the greater the risk for an infection, because a PICC line is a direct line into the body, hence why a

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visual assessment and documentation of the site is necessary every day and multiple times during the shifts when the line is accessed. Research The Institute for Healthcare Improvement (2008) states that documentation on the evidence for infection rates is still lacking and more data is needed to support the best methods that should be used to implement the insertion of a PICC line. There are standardized areas for this procedure such as sterile technique and maximal barrier precautions. As research in the medical field advances, the practices for implementing, maintaining, caring for, and removal of a PICC line will change to incorporate those new techniques. Medical procedures must be constantly evaluated and reevaluated to ensure that the best possible care is being provided and made available to the patients that need it. This quality of care for PICC lines must be able to incorporate education and communication because the insertion is usually done by a specialized nurse or an interventional radiologist (Al Raiy et al., p.151). This means that communication between multiple areas within a health care facility are reinforced to promote better outcomes. These elements of education, technique, communication, and evidence based research all work together to provide holistic care for a patient who has a PICC line. Ultimately the overall goal is to decrease their risk for infection. Conclusion Inserting a PICC line is not a one person job, rather coordination between multiple components come into play. Communication between the patient, physicians, specialists, nurses, and family must be constant and everyone needs to understand the procedure and the risks. There are reasons that evidence based practice has been established for inserting a PICC line; it demonstrates that infections are not only dangerous but deadly to an individual who has one.

PICC LINES Although there are differences between the evidence portrayed, the similarities outweigh them. Demonstrating that the important methods to follow are the ones where both stated to do the act but in finding the differences it is also noted that there must be more research done.

incorporating the best possible guidelines would promote the universal care of PICC lines across health care facilities, ultimately decreasing the risk for infection in patients with a PICC line or who are being prepped for one. Providing holistic patient care is important to every health care setting and in order to do that, the safety and quality of care must be evident and up to date with the best evidence based practice techniques being implemented.

PICC LINES References Al Raiy, B., Kale, P., Szpunar, S., Rey, J., Nenninger, T., Riegel, E., et al. (2010). Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. American journal of infection control, 38(2), 149153.

Institute for Healthcare Improvement. (2008). 5 Million Lives Campaign. Getting Started Kit: Prevent Central Line Infections How-to Guide. Cambridge, MA: Institute for Healthcare Improvement. Petree, C., Wright, D. L., Sanders, V., & Killion, J. B. (2012). Reducing blood stream infections during catheter insertion. Radiologic technology, 83(6), 532-540. Taylor, C. (2011). Theory, research, and evidence-based practice. Fundamentals of nursing: the art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.